Antidepressant Medication Management and Health Plan Employer Data Information Set (HEDIS) Criteria: Reasons for Nonadherence

Background: While nationwide data have found that many patients do not meet the National Committee for Quality Assurance uniform standards for successful antidepressant treatment, reasons for this failure are not well understood. We examined the reasons for this failure through a systematic chart review.

Method: A chart review was conducted on a random sample of 249 health maintenance organization patients who failed 1 or more of the 3 Health Plan Employer Data Information Set criteria (i.e., 3 follow-up visits or adequate duration of acute or continuation phase treatment).

Results: The most common reason for visits failure (N=192) was that the patient restarted a previously prescribed successful antidepressant (N=30, 16%). In 23 patients (12%), the patient had a visit with the prescribing provider, but mental health was not coded or documented in the case notes. Twenty-one percent (N=40) were misclassified as not having 3 visits. The most common reasons for misclassification were mental health was discussed but not coded (N=16, 8%) and wrong start dates due to use of medication samples (N=10, 5%). Patient nonadherence was the most common reason for failure to meet adequate acute (N=109) and continuation (N=99) phase duration of treatment (13% and 24%, respectively); only 9% stopped taking medication in the acute phase due to side effects. Twenty-five percent of patients had told their doctor they were taking their medication while the pharmacy database found they were not.

Conclusion: A large discrepancy between patients’ actual and reported compliance was found and may in part account for physicians’ inability to detect and thus address this issue. Patients’ restarting a previous medication is common and warrants discussion regarding differential need for visit frequency.